Social determinants of health represent those factors which, whether we have control over them or not, can significantly influence both physical and mental health outcomes. Differences produced by social injustice can (and does) produce systemic health inequities between rich and poor, with a “social gradient” in between.
The social determinants of health
The Government of Canada identifies eleven key social determinants:
- Income and social status
- Employment and working conditions: e.g. stable employment, workplace stress
- Education and literacy
- Childhood experiences
- Physical environments: e.g. substandard housing, exposure to secondhand smoke
- Social supports and coping skills
- Healthy behaviours: e.g. substance use, physical activity, and fruit/vegetable consumption
- Access to health services: this includes routine preventative services
- Biology and genetic endowment
Given this, it’s really no surprise that the Adverse Childhood Experiences study found significant long-term effects from childhood trauma and neglect. Add in intergenerational trauma and you’ve really got problems.
Adverse health outcomes
According to a Government of Canada health inequalities data tool, people in the lowest income quintile (i.e. bottom 1/5 of the distribution of incomes) are 79% more likely than people in the highest income quintile to die by suicide. That same population bracket is 123% more likely to have a hospitalization for mental illness. People ranking in the top quintile for an index measuring social and material deprivation were 173% more likely to die by suicide and 452% more likely to have a psychiatric hospitalization compared to the least deprived quintile.
A National Collaborating Centres for Public Health report cited government figures that social and economic factors account for 50% of all health outcomes. The factors contributing the other 50% include healthcare, genetics, and physical environment. In 2012, a child born in Canada’s North would have a life expectancy 14 years shorter than the Canadian average.
The U.S. Centers for Disease Control (CDC) describes social determinants of health as “life-enhancing resources, such as food supply, housing, economic and social relationships, transportation, education, and health care, whose distribution across populations effectively determines length and quality of life.”
The CDC characterizes health inequities in the U.S. as large, persistent, and growing. The diagram above shows how adverse contributing factors produce disadvantages that are “interconnected, cumulative, intergenerational, and associated with lower capacity for full participation in society.” The resultant social costs can threaten “economic development, democracy, and the social health of the nation.”
Talk isn’t enough
In 2011, the World Health Organization led a conference that produced the Rio Political Declaration on Social Determinants of Health. It identified three key areas of focus:
- Improve people’s everyday lives
- Challenge the inequitable distribution of resources
- Systematically evaluate both the problems and implemented solutions.
The declaration sounds good, but whether it will actually bring about change is another issue. “We, Heads of Government, Ministers and government representatives, solemnly reaffirm our resolve to take action on social determinants of health to create vibrant, inclusive, equitable, economically productive and healthy societies.” I suspect that anyone in a highly disadvantaged situation would probably read that and roll their eyes.
Talk is great, but this calls for action. People’s health and lives depend on it.